Published On: Fri, Jun 14th, 2013

The Care Home Funding Lottery Uncovered

Between 1960 and 2010 the average age that people live to has increased significantly. Men now live an average of 10 years longer, reaching the age of 85; and women now live 8 years longer, reaching an average age of 89. This is mainly due to advancements in medical technology which mean fewer children die during childbirth, and people are living longer thanks to improved medication and surgical procedures.

However, with more people living for longer we’ve seen an increase in the number of elderly people requiring care, either in a residential care or nursing home or with a carer who visits them in their own home. The funding for your care in old age is currently dependent upon several factors including the area that you live in, the severity of your care needs, and how much capital you have.

NHS Continuing Care
This is a care package provided by the NHS to adults who have continuing personal, social, and nursing needs. Most patients will receive this form of care from within a residential care home, but it can also be applied to other settings i.e. care for a patient in their own home. The assessment for continuing care looks at several areas of a person’s needs to determine whether or not there is a Primary Health Need present:

  • Behaviour
  • Cognition
  • Communication
  • Psychological/emotional needs
  • Mobility
  • Nutrition
  • Continence
  • Skin – i.e. wounds/ulcers
  • Breathing
  • Symptom control through drug therapies and medication
  • Altered states of consciousness

The assessor will look at all of the above and rate the severity of each, looking at things such as the complexity, intensity and unpredictability of the needs, as well as carrying out a risk assessment to determine what the outcome would be if any of the needs were not met. Each of the above is graded at one of the following levels: priority, severe, high, moderate, or low. If the patient has at least one priority need, or two severe needs then they should qualify for NHS Continuing Care. A patient should also qualify if they have one severe need along with several other high or moderate needs. The operative word here being ‘should’, because as we all know, what happens in practice is often quite far removed from what is stated in theory.

The Primary Care Trust (PCT) within each local authority is responsible for the assessment of patients applying for Continuing Care. Local authorities are renowned in the UK for not being very uniform in the way that they operate. What passes in one local authority will be refused in another. Thus we have seen many cases of patients with severe and priority needs being refused the relevant funding for their continuing care needs because of a lack of structure and understanding within and across local authorities. Since 2007 there has been a National Framework for Continuing Care assessment in place, however some cases are still slipping through the net and more work needs to be done.

What happens if a patient is refused NHS Continuing Care?
If a patient is deemed ineligible for funding through the NHS Continuing Care scheme, i.e. if their Primary Care Need has been deemed as social rather than health, then the only other option is to pay for the care themselves either in full or with a contribution from the state. This is means tested based on a person’s capital; i.e. the amount of capital a person has will determine how much they must contribute towards their own ongoing care needs.

The way that care home funding is worked out can be quite complex so I’ve tried to summarise it as simply as I can here:

  • Home Care – If you have capital i.e. savings and investments, excluding the value of your home, which exceed the upper capital threshold which is currently £23,250 in England and Wales and £24,750 in Scotland,  then you may be liable for the full cost of your ongoing care in your own home. Those whose assets are less than £23,250 will receive a proportionate contribution towards their care costs from their local authority. Capital of £14,250 or below is ignored by the means testing, but capital between £14,250 and £23,250 is counted as providing an additional £1 of income per week for every £250 held. A person’s care fees should not reduce their remaining income to less than 1.25 times the Pension Credit basic Guarantee Credit, which is currently £171.69 per week.
  • Care Home – If a person needs to be looked after in a care or nursing home then they are liable for the full fees if their overall capital, including the value of their home exceeds the threshold set by each country within the UK, which is currently £23,250 in England and Northern Ireland, £23,200 in Wales, and £24,740 in Scotland. A person’s home is exempt from inclusion as capital if it is still lived in by a surviving spouse, a relative aged over 60 or incapacitated, or a child under 16 who is a relative of the homeowner. If a person’s total capital falls below the threshold then they are entitled to a financial contribution from the local authority towards their fees.

Case Study
Former professional footballer Peter Sampson was diagnosed with Alzheimer’s in 2004. His care needs were so severe that he ended up having to go into a residential nursing home. However, the PCT within his local authority in Somerset assessed him and came to the conclusion that his Primary Care Need was social rather than health. This was despite the fact that his Alzheimer’s had progressed to the stage where he couldn’t walk unaided, couldn’t feed himself, and was incontinent. At the time, the only way that he could afford to pay for this was to sell the home that he had lived in for almost 50 years. Mr Sampson’s family took up the case with a solicitor and the case was reassessed, the family went on to win compensation for the fees, however by this point unfortunately Mr Sampson had sadly passed away.

Looking to the future
In response to the Dilnot Commission’s recommendations published in July 2011, as of April 2017 the upper threshold for total capital will be increased substantially to £123,000; meaning that anyone entering a care home after this date with total assets of less than £123,000 will not have to pay the full cost of their care. However, care home residents will then be charged ‘hotel’ costs for board and lodgings, capped at £10,000 annually. Once these recommendations come into place in 2017 there will be a cap introduced meaning that once an individual has paid £75,000 towards their own ongoing health and social care then the state will cover all further care costs therein.

This is obviously great news for anyone needing the assistance of a care or nursing home in 4 years. But over these next 4 years we’re still likely to see many elderly and vulnerable people suffering in their old age whilst their life savings, what should have been their children’s inheritance, dwindles away to pay for their care. Age UK believes that the powers that be should make a compassionate gesture to help those who are currently suffering under the system we have in place now. It is a system that has denied many elderly people the dignity and peace which they rightly deserve in their twilight years, and I for one welcome the changes in 2017.

 

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